Chapter 10: Abdominal Disorders

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. Your 70-year-old patient has gastroesophageal reflux disease (GERD). After a trial of lifestyle
modifications and antacids, the patient continues to have occasional mild heartburn after occasional
meals and at night. The most appropriate next action is:
A. Prokinetic agents
B. H2 antagonists
C. Proton pump inhibitors
D. Surcralfate

____ 2. An older patient reports burning pain after ingestion of many foods and large meals. What
assessment would assist the nurse practitioner in making a diagnosis of GERD?
A. Identification of a fluid wave
B. Positive Murphy’s sign
C. Palpable spleen
D. Midepigastric pain that is not reproducible with palpation

____ 3. The nurse practitioner is examining a 62-year-old female who has been complaining of lower
abdominal pain. Upon auscultation, bowel sounds are high pitched and tinkling. Which of the
following terms describes this finding?
A. Succession splash
B. Borborygmi
C. Tenesmus
D. Puddle sign

____ 4. In teaching an older adult female client with end-stage renal disease her medication regimen, the
nurse practitioner must include which of the following pieces of information in the treatment plan?
A. Report any changes in the color of her stool
B. Take iron supplement and elemental calcium with each meal
C. Take iron supplement before meals and the calcium after meals
D. Take calcium with a high phosphorus meal

____ 5. A 62-year-old client presents with a complaint of fever, pain, and burning on urination. Difficulty
urinating with dribbling has been increasing in the past few days. He has a feeling of pressure in his
groin. On examination, his prostate is tender, boggy, and warm. A stat urinalysis reveals the presence
of leukocytes and bacteria. He is allergic to sulfa drugs. His weight is 70 kg and his last serum
creatinine was 1.0. While awaiting the culture and sensitivity, the nurse practitioner begins empiric
treatment with which of the following?
A. Trimethoprim/sulfamethroxazole DS bid x 2 weeks
B. Ampicillin 250 mg PO q day for 10 days
C. Nitrofurantoin 100 mg Q 12 hours for 7 days
D. Ciprofloxacin 500 mg Q 12 hours for 14 days
____ 6. A 62-year-old woman presents with a recurrent urinary tract infection. She now has a fever of 104°F
and severe costovertebral tenderness with pyuria. What is the appropriate diagnosis and intervention
for this patient?
A. Septic arthritis and oral prednisolone is indicated
B. Pyelonephritis and hospitalization is required
C. Recurrent cystitis and 10 days of antibiotics are needed
D. Pelvic inflammatory disease and 7 days of antibiotics are indicated

____ 7. Which of the following drugs would be useful for the nurse practitioner to prescribe for an older
adult to prevent gastric ulcers when a nonsteroidal anti-inflammatory drug is used for chronic pain
management?
A. Misoprostol (Cytotec)
B. Cimetidine (Tagamet)
C. Metronidazole (Flagyl)
D. Bismuth subsalicylate (Pepto bismol)

____ 8. A 68-year-old male reports painless rectal bleeding occasionally noted with thin pencil-like stools,
but no pain with defection. He has a history of colon polyp removal 10 years ago but was lost to
follow-up. The nurse practitioner’s appropriate intervention is:
A. Digital rectal exam and send home with 3 hemoccult to return
B. Immediate referral to gastroenterologist and colonoscopy
C. Order a screening sigmoidoscopy
D. Order a colonoscopy and barium enema and refer based on results

____ 9. Asymptomatic 1+ bacteruria is found in a nursing home resident with an indwelling catheter. The
nurse practitioner’s initial intervention includes:
A. Assessing resident’s cognitive status and last change of the catheter/bag
B. Prescribing prophylactic Bactrim 1 tablet at bedtime
C. Ordering a urine culture and sensitivity and prescribing empiric treatment until
results obtained
D. Ordering an x-ray of the kidney, urine, and bladder

____ 10. When counseling clients regarding the use of antidiarrheal drugs such as Imodium anti-diarrheal and
Kaopectate, the nurse practitioner advises patients to:
A. Use all the medication
B. Do not use for possible infectious diarrhea
C. Use should exceed one week for effectiveness
D. These drugs provide exactly the same pharmaceutical effects

____ 11. When teaching a group of older adults regarding prevention of gastroesophageal reflux disease
symptoms, the nurse practitioner will include which of the following instructions?
A. Raise the head of the bed with pillows at night and chew peppermints when
symptoms of heartburn begins
B. Raise the head of the bed on blocks and take the proton pump inhibitor medication
at bedtime
C. Sit up for an hour after taking any medication and restrict fluid intake
D. Avoid food intolerances, raise head of bed on blocks, and take a proton pump
inhibitor before a meal
____ 12. A clinical clue for suspected renal artery stenosis would be:
A. Decreased urine output
B. Development of resistant hypertension in a previously well-controlled patient
C. Retroperitoneal pain on the affected side
D. Rising BUN level with normal creatinine level

____ 13. Helicobacter pylori is implicated as a causative agent in the development of duodenal or gastric
ulcers. What teaching should the nurse practitioner plan for a patient who has a positive
Helicobacter pylori test?
A. It is highly contagious and a mask should be worn at home.
B. Treatment regimen is multiple lifetime medications.
C. Treatment regimen is multiple medications taken daily for a few weeks.
D. Treatment regimen is complicated and is not indicated unless the patient is
symptomatic.
____ 14. An obese middle-aged client presents with a month of nonproductive irritating cough without fever.
He also reports occasional morning hoarseness. What should the differential include?
A. Atypical pneumonia
B. Peptic ulcer disease
C. Gastroesophageal reflux
D. Mononucleosis (Epstein-Barr)

____ 15. Which of the following findings would indicate a need for another endoscopy in clients with peptic
ulcer disease?
A. Cases of dyspepsia with constipation
B. Symptoms persisting after 6-8 weeks of therapy
C. All clients with dyspepsia who smoke and drink alcohol
D. When a therapeutic response to empiric treatment is obtained

____ 16. A careful history of a female client with a chief complaint of intermittent diarrhea reveals that she
also experiences bouts of constipation. She has no known allergies and experienced no unintentional
weight loss. What is the most likely condition?
A. Inflammatory bowel disease
B. Irritable bowel syndrome
C. Giardiasis
D. Lactose intolerance

____ 17. The nurse practitioner is discussing lifestyle changes with a patient diagnosed with gastroesophageal
reflux. What are the nonpharmacological management interventions that should be included?
A. Weight reduction and rest 30 minutes after each meal in the supine position
B. Elevation of head of the bed 4-6 inches on blocks and weight reduction
C. Encouraged to wear restrictive clothing to add support for diaphragmatic breathing
D. Using oral mints to relieve gastric distress

____ 18. In differentiating a gastric ulcer from a duodenal ulcer, you know that each type of ulcer can present
with distinct signs and symptoms. Which of the following pieces of information from the patient’s
history is the least useful for you to determine that the patient has a duodenal ulcer?
A. Pain occurs on an empty stomach
 B. Diffuse epigastric pain
C. Rarely associated with non-steroidal use
D. Occurs in patients under 40 years of age

____ 19. A 74-year-old obese female presents complaining of persistent right upper quadrant pain. She reports
that she has not had any prior abdominal surgeries. Which of the following laboratory studies would
be most indicative of acute cholecystitis?
A. C-reactive protein level of 3 mg
B. White blood cell count of 11,000
C. Direct serum bilirubin level of 0.3 mg/dL
D. Serum amylase level of 145 U/L

____ 20. Which of the following is not a contributing factor to the development of esophagitis in older adults?
A. Increased gastric emptying time
B. Regular ingestion of NSAIDs
C. Decreased salivation
D. Fungal infections such as Candida
Chapter 10: Abdominal Disorders
Answer Section

MULTIPLE CHOICE

1. ANS: B PTS: 1
2. ANS: D PTS: 1
3. ANS: B PTS: 1
4. ANS: C PTS: 1
5. ANS: D PTS: 1
6. ANS: B PTS: 1
7. ANS: A PTS: 1
8. ANS: B PTS: 1
9. ANS: A PTS: 1
10. ANS: B PTS: 1
11. ANS: D PTS: 1
12. ANS: B PTS: 1
13. ANS: C PTS: 1
14. ANS: C PTS: 1
15. ANS: B PTS: 1
16. ANS: B PTS: 1
17. ANS: B PTS: 1
18. ANS: B PTS: 1
19. ANS: D PTS: 1
20. ANS: A PTS: 1